EMILY LOUISE WICKERSHAM (DO) – Anatomic Pathology & Clinical Pathology Physician, NPI 1093175358
Anatomic Pathology & Clinical Pathology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
57 PATHOLOGY in HI
Provider Addresses for EMILY LOUISE WICKERSHAM (DO)
1 JARRETT WHITE RD
TRIPLER AMC, HI 968595001
Phone: (808) 433-5266
Fax: (808) 433-6127
Type: Mailing
Madigan Army Medical Center, 9040, Jackson Avenue, Tacoma, Pierce County, Washington, 98431, United States
TACOMA, WA 984311000
Phone: (253) 968-2252
Type: Location
19135 PAWNEE CT
SAINT JOSEPH, MO 645058901
Phone: (309) 258-5813
Type: Mailing
1500 N OAKLAND AVE
BOLIVAR, MO 656133099
Phone: (417) 326-6000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20241127003054 | I | Pathology | MO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 96859)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Emergency Medicine | MO | |
| - | MO | |
| Certified Registered Nurse Anesthetist (Crna) | MO | |
| P A T H O L O G Y | MN | |
| Interventional Pain Management, Anesthesiology | NM | |
| Emergency Medicine | MO | |
| - | MO | |
| Certified Registered Nurse Anesthetist (Crna) | MO | |
| Certified Registered Nurse Anesthetist (Crna) | MO | |
| Diagnostic Radiology | MO |
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